LAUSR

Study objective: To assess the performance of empiric evaluation of prognosis in patients with acute pulmonary embolism (PE). Methods: We compared the test characteristics of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI), and the empiric assessment of: two internal medicine senior physicians (with [A1], and without [A2] clinical experience in venous thromboembolism), a fourth year resident training in respiratory medicine (R4), a third year resident training in respiratory medicine (R3), and a second year resident training in respiratory medicine (R2), for predicting 30-day outcomes in a cohort of 154 patients with objectively confirmed PE. The primary outcome of the study was 30-day all-cause mortality. Results: Overall, 13 out of 154 patients died (8%; 95% confidence interval [CI], 3% to 14%) during the first month of follow-up. Across experience level, there were statistically significant differences in the percentage of patients for whom physicians considered to be at low-risk (Figure). There was a trend toward increasing accuracy with increasing experience, demonstrated by the frequency of true-negative assessments. Conclusions: Experienced clinical gestalt is as useful as standardized prediction rules to assess patient eligibility for the outpatient treatment of PE. Accurate risk-stratification of PE patients appears to increase with clinical experience.